(003) Assessment of medication adherence and the impact of clinical pharmacist interventions on medication adherence among systemic lupus erythematosus patients: a prospective cohort study

Background: Multiple drug regimens are common in systemic lupus erythematosus (SLE) patients due to multiple comorbidities and complications. This increases the risk of medication non-adherence. Data on the impact of clinical pharmacist interventions on improving medications in SLE patients is limited.

Objectives: This study aimed to assess medication adherence and the impact of clinical pharmacist interventions on medication adherence among SLE patients.

Methods: A prospective cohort study was conducted at rheumatology department in a tertiary care teaching hospital for 36 months. Patients of either gender, aged ≥16 years, diagnosed with SLE admitted to hospital or visited outpatient department and receiving at least one medication were included in this study. Study eligible patients were randomly assigned (1:1) into usual care group (UCG) and multidisciplinary care group (MDCG). Clinical pharmacist collected study-relevant data from patients daily during ward round or outpatient department visit. Patients in MDCG received clinical pharmacist interventions including patient counselling and pill count method plus standard clinician care while patients in UCG received only standard clinician care. Medication adherence was measured using Medication Adherence Rating Scale (MARS) that contains 10-item questionnaires. MARS score was measured during baseline visit, 3 months and 6 months of intervals in both groups. SPSS V25 was used for statistical analysis.

Results: Of the 202 SLE patients, majority of patients were females 182 (90.1%). The mean age of SLE patients was 37.4 (SD±11.50) years and 62.4% (n=126) of patients belonged to the age group of 18-39 years. Majority of patients 166 (82.2%) had a history of taking more than 5 medications. At baseline, overall mean MARS score was found to be 4.26 (SD ± 1.4) [UCG: 4.52 ± 1.22 Vs. MDCG: 4.01 ± 1.61] while at 6 months follow-up, mean MARS score was 6.73 (SD±2.6) [UCG: 5.22 ± 2.54 Vs. MDCG: 8.25 ± 2.66]. The difference on mean MARS score between baseline visit and 6 month follow-up at MDCG was statistically significant (p < 0.0001). Further, at baseline, 61 (30.1%) patients [UCG: 32 (31.6%) Vs. MDCG: 29 (28.7%)] were compliant towards medication uses while 105 (54.7%) patients [UCG: 34 (36.2%) Vs. MDCG: 71 (73.2%)] were compliant at 6 months follow-up. The difference in compliance towards medication use between baseline visit and 6 month follow-up at MDCG was statistically significant (p < 0.0001).

Conclusions: Clinical pharmacist interventions help to increase medication adherence by enhancing patient compliance towards medication use among SLE patients. Therefore, clinical pharmacist and clinician participation is essential to ensure patients’ adherence towards medication use.